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Images in Neurology
July 2012

Eight-and-a-Half Syndrome: A Rare Pontine Neuro-ophthalmologic Syndrome

Arch Neurol. 2012;69(7):934-935. doi:10.1001/archneurol.2011.2185

A 36-year-old woman presented with left gaze limitation and right eye limitation of adduction with horizontal nystagmus on abduction (one-and-a-half syndrome) in addition to a left-sided lower motor neuron facial nerve palsy (Figure 1 and video). Magnetic resonance imaging revealed an area of hyperintense signal extending beyond and lateral to the paramedian pontine territory and ventrally to the fourth ventricle, including the region of the facial colliculus. The lesion, which was characteristic of those found in demyelinating conditions,1 was clearly demonstrated on fluid-attenuated inversion recovery sequences (Figure 2). The clinical and radiologic presentation was consistent with multiple sclerosis.